HomeMy WebLinkAbout0067 SCREECHAM WAY � � ��`�
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Town of Barnstable Building
Post This.Card So T.,hat°�t�s:Visible From the'.Street Approved Plans Must be Retained on Job and, this Gard Must be Ke'°t r,;
QAItNtTPA{ti:L, ,�� a r L r '., a .s" ,a' .. xr �.s ✓S'� s P ,3
M' PostedUntil�Final lnsectionHasBeenll%lade� '< ;' m ,
° Where a Certificate of OccUpancyisRequ�red,such Buildmg�shallNotbe Occupiedvunt�l a Final inspection hasbeen made Permit
Permit No. B-18-1276 Applicant Name: Henry Cassidy Approvals
Date Issued: 05/18/2018 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 11/18/2018 Foundation:
Location: 67 SCREECHAM WAY,COTUIT Map/Lot 022-131 Zoning District: RF Sheathing:
Owner on Record: SKINGSLEY,PAULINE F Wl
il ContractorName HENRY E CASSIDY Framing: 1
Address: 67 SCREECHAM WAY Contractor License, CS 100988 2
COTUIT, MA 02635 -
� aEst"Protect Cost: $ 1,700.00 Chimney:
Description: 8 hrs airsealing, R10 rigid bd to 168sq ft in crawlsp5ce,1119 unfaced Perm�tkFee: $85.00
fiberglass to flat attic &
Insulation:
s h Fee Paid:E $85.00
Pro1°ect Review Re Final:
q Date 5/18/2018
A f t Plumbing/Gas
Rough Plumbing:
Building Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six�months after issuance.
All work authorized by this permit shall conform to the approved application and the approved construction documents forwhich this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures'shall be in compliance with the local zonmgby lawsand codes.
This permit shall be displayed in a location clearly visible from access street or�"road and shall be maintained open for public inspection for the entire duration of the Final Gas
work until the completion of the same.
Electrical
The Certificate of Occupancy will not be issued until all applicable signatues by the BIdmg and;Fire Officials are provided on thipermit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing I V.
2.Sheathing Inspection ' a., �., : . . . Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department '
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
D6v`�E
f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application# �� H
Health Division
Conservation Division Permit#
Tax Collector Date Issued
Treasurer Application Fee
Planning Dept. Permit Fee gyp„
Date Definitive Plan Approved by Planning BoardY "
Historic-OKH Preservation/Hyannis
Project Street Address
Village cowl
Owner S Lautwe, Address 7 -
Telephone 5-C�a �- a�9- (2 7® S n
Permit Request uln Poncc k 1. j L A.)Doug .Coei t-! y ra i O n
&)pw WkA.,�Dou_)S lL� Ah Qeo 0119enin Oil - 3Formen
�( wa l I r U►'1 (kG
Square feet: 1st floor:existing 193 proposed Az A- 2nd floor:existing proposed AIA- Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 900,,Construction Type W L&2J7oc�,S
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family & Two Family ❑ Multi-Family(#units)
Age of Existing Structure a ` d-5 Historic House: ❑Yes 151 o On Old King's Highway: D�Yes
/
Basement Type: &Fgull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) �✓,� Basement Unfinished Area(sq.ft) <Sj
c„ c ,
Number of Baths: Full:existing new ,t/.* Half:existing ' .new
Number of Bedrooms: existing new
Total Room Count(not including baths):existing new First Floor Roo�Count a
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other A4 A' A)O i ee--
Central Air: ❑Yes �❑No Fireplaces: Existing AIA New Existing wood/coal stove: ❑Yes ❑No
Detached garage:®'existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing L new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name Iq,4rk 0 i9A-fn 5 Telephone Number
Address 9 L4 Ca,-irbroak 120 License# C 5 01 q oZ 0/5
tV- '-IA-02 nyy%1t A . , 0 2_&-7.? Home Improvement Contractor# /3 5-7 79
Worker's Compensation# ftwg 702p q dJ/ 2op(o
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &rri5i6bL00,
SIGNATURE��B'/ �� /�. �r,� � DATE /2—A)
FOR OFFICIAL USE ONLY
PERMIT NO.
ti
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
� 1
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
r
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
ti r GJ
FINAL BUILDING
• T
DATE CLOSED OUT ,
ASSOCIATION PLAN NO.
r"
The Commonwealth ofMassachusetts
Department oflndustridAccidents
Office of Investigadons
w 600 Washington Street
Boston, MA 02111
y wtvw.massgov/dia-
workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Budaesdorganizatimudividu4: PW`J 013 .4
Address: `� .Ea5:b no®fiC Rd
City/Statel* • J.V M 0 ill-h Phone#: SO 1— 3 9 Y--fo/7 7
Are y an employer? Check the-appropriate bog: r Type of project(require ci):
1,VI am a employer with 1 4. ❑I am a general contractor and I 6. ❑remodeling
onstruc�tion
employees (tn and/or part tmne).* have l ired the sub-contractors
2.❑ I am a sole proprietor,orpartaer listed on the attached sheet t 7.
ship and have no employees These sub-contractors have & ❑ Demolition
working for me in any capacity. workers' comp,insurance. 9. ❑ Building addition
[No workers' wrap.insarmee 5. ❑We are a corporation i ad its
required.] officers have exercised their 10.❑ Electricalrepaas or,additions
3.❑ I am a homeowner doing all work right of exemption per MGL l l.❑ Ph mNng repairs or additions
' nryself.(No workers' comp, c. 152,§1(4),and we have no 12.0 Roof repairs
lance rcgvired.]t . employees.(No workers' ' 13.❑ Other
comp,fiom mce required.]
*Amy znUcaat that cheeks box#1 mast 4so M out the secdcm below showing ffisa work ,ocmpemca'tlon polieyinfortaetioa: `
t Ecmeown=who submit this affidavit indicating they are daiag aU work aadthen hire outside coattavtora must submit anew aEMavit indicating such
3Ccn h actors that check bats boa mnst attached as additional sheet showing the acme of the aub.contractvm sad their woikere comp policy iafb=agdj a.
ram an employer that is providing workers'compensation insurance formy employees. Below is the p4l0 and,�ob site
Information. / :J.
'Insurance Compaay Name: 05 5�G/�kQ4 l:i(>�i�Skcl eS O('+ M UJWZ I A6. Co
Policy or .tire. ev C- o Zo e-i ® 1 a oy (7Ia .l lam/ d 7. ,
Job Site Address: 7 ��L�'',G eC ABM WA•cf City/state/Zip: a
Attach a copy of the workers' compensation policy declaration page(showing the policy number and W.1ration date).
Failure to sear.c coverage as required undet Section 25A of MGL c. 152 nari lead to-the imposition of criminal penalties of a-
fine up to$1,50090 and/or one-year imprisonment,w well as civil penalties in the_forra of a STOP WORK ORDER and a lime
of up to$250.00 a day against the violator. Be advised that a copy of this stateramrt may be forwarded to the Office of
Investigations of the DIA far insurance coverage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
sjnat►u__/ a'do- ��1�� Date: 1�7/s/o�v
Phone#: 570 5� — _�— t'o 1.7
r a'a,i u36 . Do e 1r, arm,to k cue d.b,ck,of t"M ,jllwid
City or Town: PermhMicense#
l
Issuing Authartty(circle one):
1.Board of Health 2.Building IDepartmen` 3.City/TI own Clerk a.Electrical inspector 5.Plumbing iuspr=&Lor•
6.Other
CQ �act per5fl�: Phone#:
Information and Instructions
Massachusetts General Laws chapter l52 requires all employers to providewbrkeW compensatimfor-tbeir employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hoe,
express or implied,.QiA or written."
An employer is defined as-"an individual,partnership,association,corporation dr other legal entity,or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceas ed employer,or the .
receiver or trustee of an individual,partnersht, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on snrh dwelling house
or m the grounds Or building appurtenant thereto shall not because of such employment be deemed tobe an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate it business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
AdditionaUy,MGL chapter 152, §25C(7)states"Neither 1he commomwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpubEc work untz7 acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checldmg the boxes ftt apply to your situation and,if
necessary,supply sub-contractc*)name(s),address(es)and phone numbers)along with their certificates)of
insurance, Lkated Liability Companies(LLC)or'Lizn t Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The•affidavit should
t a returned to the city or.t own that the application for the permit or license is being requested,-not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain it workers'
compensatimpolicy,please call the Department at the number listedbelow. Self-insured coarpaaies 1-hM nt[ficr their
self-insurance license number on-the appropriate 1iae.
City or Town Oft9ciah .
?lease be sure that the 01davit is complete and printed legibly: The Department has provided s space at the bottom.
of t�affidayg for you to fill a&-In the eyed the Office of Ir vesdiatims has to contact you regarding the applicant -
Plesse be sure to fhll in the permit/ficeme ntunber which wi l be used as a reference sccbtr. Inn addidM an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job.Site Address"the applicant should write"all locations in_- (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the
applieantas proof that•a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each '
year.Where a dome owner w citizen is obtaining a license or permit nptrelated to any business or commercial venture
(to. a dog license or permit to burn leaves etc.)said person is NOT requfred to complete this affidavit
The Office of Investigations would lie to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give as a call.
'The Department'a address,telephone and fax number:
Tie Cammonweal. of-Musadmsett
Department of Industrial Accidents
Office of
600 Washington Street
Boston,MA 02111
Tel. ff 617-727-4900 e-xt 406 or 1 o77-MASSAFE '
Fax 0 617-727-7749 .
Revised 5-26-05 ww wmass.gov/dia
I
i
oF � Town of Barnstable
Regulatory Services
s"�1ST/8 Thomas F.Geiler,Director `
bins. g
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no. "
Date •
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
-improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: N'OC 0 1 Estimated Cost � l� 70 ,
Address of Work: &7 Scree G`ia✓Y1 uz gy.
Owner's Name:
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
MWork excluded by law
[]Job Under$1,000
[]Building not owner-occupied
[]Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME MROVEM[ENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PEM--RY
I hereby apply for a permit as the agent of the owner:
Y,
Date Contractor Name Registration No.
OR
Date Owner's Name
QArms.homeaffidav
I
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
r
New Buildings $100.00
Residential Addition $ 50.00 I
Alterations/Renovations $50.00 k
Gl Change of Contractor/Builder . $25.00
FEE VALUE WORKSHEET I
NEW LIVING SPACE
square feet x$96/sq. foot= x .0041=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
123 square feet x$64/sq. foot= 1,2, x .0041= �I
plus from below(if applicable)
i
GARAGES(attached&detached)
i
square feet x$32/sq. ft.= 1 x .0041=
ACCESSORY STRUCTURE>120 sq. ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x .0041=
STAND ALONE PERMITS
Open Porch x$30.00=t
(number)
Deck x$30.00=
De 'a
(number)
i
Fireplace/Chimney x$25.00=
(number) i
Inground Swimming Pool $60.00
Above Ground Swimming Pool $25.00
Relocation/Moving $150.00
(plus above if applicable)
tPermit Fee
Projcost
Rev:063004
M CMR AppaWk J
Table JS 2-lb(eonttnaed)
Prescriptive Packages for One and Two-family Residential Buildings Heated with"fusaii fuels
' 1
MAxim-uM MINIMUM
Glazing Glazing Ceiling wall Floor Basement slab HeatinglCooling
Area'(%) U-value= R-valutr R-value' R-value° wall Perimeter Equipment Efficiency'
package R value° R-value'
5701 to 6500 Heating Degree Days'
Q� 12% 0.40 38 13 19 10 6 Normal
R 12% 0.52 30 19 19, 10 6 Normal
S 12% 0.50 38 13 19:. 10 6 85 AFUE
T 15% 036 38 13 25. N/A NIA Normal
U 15% 0.46 38 19 19. 10 6 Normal
V 15% 0.44 38 13 25. NIA NIA 83 AFUE
w 15% 0.52 30 19 19. 10 6 85 AFUE
X 19% 032 38 13 25 . N/A NIA Normal
Y 18% 0.42 38 19 25 N/A NIA Normal
Z 18% 0.42 38 13 19 ,1 16 6 90 AFUE
AA 18% 0.50 30 19 19 10 6 90 AFUE
i
I. ADDRESS OF PROPERTY:
co lurf
2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: O
3. SQUARE FOOTAGE OF ALL GLAZING: 5j q`7 .S r.
4. %GLAZING AREA(#3 DIVIDED BY#2): 3 -2-
5. SELECT PACKAGE(Q—AA-see chart above): �¢
NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
1 .
BUILDING INSPECTOR APPROVAL:
YES: NO:
I
q-forms-f980303 a
i
i
780 CMR Appendix J
Footnotes to Fable J4.2.1b:
' Glazing area is the ratio of.the area of the glazing assemblies (including sliding-glass doors, skylights, and
basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall
area,expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement.
For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area.
2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with
the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for
whole units:center-of-glass U-values cannot be used.
' The ceiling.R-values do not assume a raised or oversized buss construction: If the insulation achieves--the full
insulation.thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38
insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity
insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between
the conditioned space and the ventilated portion of the roof.
'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include
exterior siding, structural sheathing,and interior drywall. For example,an R-19 requirement could be met EITHER
by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to
wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction.
The floor requirements apply to floors over unconditioned spaces (such as.unconditioned crawlspaces,basements,
or garages).Floors over outside air must meet the ceiling requirements.
'The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must
meet the same R-value requirement as above-grade walls. Windows and sliding. glass doors of conditioned
basements must be included with the other glazing. Basement doors must meet the door U-value requirement
described in Note b.
'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs.
' If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more
than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest
efficiency must meet or exceed the efficiency required by the selected package.
'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a
NOTES:
a)Glazing areas and U-values are maximum acceptable levels.Insulation R-values are minimum acceptable levels.
R-value requirements are for insulation only and do not include structural components.
b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested
and documented by the manufacturer in accordance with the NFRC_test procedure or taken from the door IJ-value
in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the
glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.
One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35).
c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with
different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to
the R-value requirement for that component. Glazing or door components comply if the area-weighted average U-
value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors).
43
Town of Barnstable
Regulatory Services
� MASS, � Thomas F.Geiler,Director
f6?9 Building Division.-
MA'S a � on. .
Tom Perry, Building Commissioner
200 Main Street, Hya=is,MA a2601
www.town.b arnstabl e.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This' Section
If Using A Builder
S;
1
I, joa G[ I ti e 51,,I ,as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for.
J.
V? SGqe�rhaim /,llama
(Address of Job) �
?,cam "
' Z a,6
Signature of Owner Date
pe-
Print I�Tame
Q TORMS:O WNERPERMISSION
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
i INFORMATION PAGE I
Associated Industries of Massachusetts Mutual Insurance Company
Burlington, Massachusetts
(800)876-2765 NCCI NO 26158
POLICY NO. AWC 7020499012006
ITEM PRIOR NO. I NEW BUSINESS
1. The Insured Mark Adams dba A&B Renovations
Mailing Address: 24 Fastbrook Road West Yarmouth MA 02673
(No. Street Town or City I county State Zip Code
® Individual ❑ Partnership ❑ Corporation ❑ Other FEIN 01-9585612
Other workplaces not shown above:
2. The policy 01/13/2006 to 0111 3/2 0 0 7 i
p cy period is from 12:01 a.m.standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here;
MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A
The limits of our liability under Part Two are: Bodily Injury by Accident$ 100,000 eachaccident
Bodily Injury by Disease $ 500,000 policylimit
Bodily Injury by Disease $ 100,000 each employee
C. Other States Insurance:Coverage Replaced By Endorsement WC 20 03 06A
D. This policy includes these endorsements and schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans.
All information required below is subject to verification and change by audit.
I
Classifications Premium Basis Rates
i
Code Estimated Per$100 Estimated
No. Tom Annual of Annual
Remuneration Remuneration Premium
i
INTRA 366626
SEE NSION OF INFORI 4ATION PAGE
Minimum premium$ 500.00 Total Estimated Annual'Premium $ 3.546.00
As indicated,interim adjustments of premium shall be made: Deposit Premium $ 3,689.00
® Annually ❑ Semi Annually ❑ auarterty ❑ Monthly
MA Assessment Chg.
$3251.00 x 4.4000% $143.00
This policy, 9 y ! ff
p cy,including all endorsements,is hereby countersigned b l� 01/27/2006
Authorized Signature Date
GOV GOV• KIN9704
PLACING. CLAIM NAME SAFETY
STATE CLASS AUDIOFFICE OFFICE CHECK GROUP Mark T Vokey Ins Agcy Inc
MA 5645 P O Box 1247
WC 00 00 01 A(11-88) West Chatham,MA 02669
Indudes copyrighted matarfal of Ore National Couna7 on Compensation Insurance,
used vVM' RS pemdssion.
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GULAIIONS
OF gU11 DING ERVISOR j
BOARD T.ION S
ONSTRIIC ;
aI` 1jeen$e � 07429B .
8 0. 90.400
PI �:07 Tr.n a
AR►'�R AD �.. a osier !.
24 FAST 0 HK NIA�25'f3 '*"miss
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR; before the expiration date. If found return to:
Board of Building Regulations and Standards
Registration,)35899 One Ashburton Place Rm 1301
Expiration` 511 /2008 ! Boston,Ma.02108
Type
+ sr I
A+B RENOVATIONS I
MARK ADAMS
24 FASTBROOK RD
ot valid without signature
W.YARMOUTH,MA 02673 Deputy Administrator N
I - .
MR
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s ROUGH OPENING 2 +x - VISIBLE 1.'�� STANDARD'
k 'J ii WIDTH VENTILATION AREA y, O
''.-CLEAR*,+s `'am sWITH SCREEN'' GtA55AREA;F�.G y :
, 'i ' .WIDTH HEIGHT ti�OPENING� -�,INC,HES)� "'•IMCyES .I�PTf ,� (SQ T) PATTERN
$ : INCHES}�: . 4w2h
"•UNIT CODE ti:ONCHES) .al,n 8.379 _�t 001 'S" 2 444€�_ l ,
i 207; 20.750 4w3h
.7HS2424 244�� ^, 8379 595 ,q } f 4w3h
Fa 3 939
• 24 - �"` "z 32.750 8.379 _ j
7HS2430 _ 24 6 36_•+^ 1 905 11c379 .1 360 Qks ,Z 3 259 4w2h Ir
7H52436 1 639'' 20J50 ., "•- '� 4256
7H53024 r.30;" .a24• - '-, 11:379 1 763 2 -
' 30 2113 26750 �_2166 5254 ` �4w3h 1
7H53030� = 30, 36 x :, ¢ 2.567;•,,. 32:750 k, r y17,379 3 " 2 569 6 257 4w4h
7HS3036 r 30 � 42 3062" 38.750 11.379 t718 4074 .- # 4w2h I
7HS3042 30 20Z50 14,379E r.�'• 2x 4
24 _ 2 077;;,,, s*, - 2 227.-s 5 322 R 4w3h .. -
-7HS3624 36 1 26750 74.379 f.,z,;, µ r � ---
30 2 67f x F _ 6 569 4w3h"+-
7HS3630 36 -� ' 3 32.75p 1a379 ;r2737 �% '.: "IT
I {
3270} _ � 3246 `7816 - 4w4h:�
7H53636/ -? 36•r 36 42 3 869' �'38.750 - 74 379 _ 9,664 4w4h.£
36
ZH53642 36 x 48 s s 4 468- 44.750 �•';`'74 379 1' 4 265 l0 311.- �• 4w5h
7HS3648•_ r„ •36',r.".u: a 54 5.067.,y 50.750 x.14 379 ..'`W,4 Z74
r 7HS3654; ..60c,,:` '.` 5.666 56."750 2.435,
-» 5 704'a 4w2h
*71 5 660 36 - 20750 20 379 - �»• wa_
•2q. 2.936
.7HS4824 30,,�.; *" 3 its „ 26,750 '20 379 'ry - 9.199 4w3h
',]HS4830 n .; 36 ^. 4 634 32.750 f q 60"'k 10 946:+. 4w4h
7- 36 48 M - 5 483 38.750;. �_20.374, x 12 694
7H54842 *` ,, 48 '* ,a.42 �. 44.750 ,�":20 379 5 322 n 4w5h°< a,�*yaz ' ' i v n f -' *,=
__'7H54848'z .� 48 4S 6333 50750 20379£�t', 6044x,P e 14441. ,7•1` .
48 ""y sa w _T•? n' 6.766 16.189 4w5h= ;SLIDER FRAME CyROSS SECTION,
7H54854` 60 8.031 56.750 20 379 - 7 334 4w2h=
7NS4860 - 48 '20.750 26379 - A, 3153 a .0 4w3h
7H56024`,' , 60 26379 4087 s 9582j§ Scale 1 1/2"=1'0"
` 4.900 26.750 4
60 30 a:• "°e26 379!, 5 027.t'
7H56030 - t 36 •• '"5.989 32.750 1407,7 4w-h
7HS6036• 's 60 e P - 38:750 26379' 5955
60 42 ' 7.098 ;•26 379 6.890;
7H560-2 '' - 48: `&79Z 41750 .:` 7 824 18.571 4w5h
.7H56048 r.: ,5'.60 r -26379 -
60 54'� 9.296 .. e �.50 750 -�*' '`-"`"�8 758 %r f 280.815
7H56054 4a, * 60k`-.10.395�7" •'..56 750 '`26 379 :96. _ ': -
4w5t
7HS6060 'sue' ' 4.665 =• .20 750 -32 379 3 870
6w2h
5017 11 Z72 ¢ 6w3h
7HS7224
S7 ?' 30 �"t 6 014� �'.26 750 .32 379 14 459 6w3h
7H230 72 7 363 32 750 32 379 ry 6 163 a 1}Y7 6w4h I +
7H57236 s z 36' 38 750 z'� 32 379 b 7 310
72 y„ � 17 207 s
72 , 42 8713 .. �, " 8 457 79 954 x 6w4h .•
7HS7242,..:SF"p- t"` 10.062 44750 32379 6w5h
--7H572gg 72 . L 48" 379�'
.� 54.'' 11.411' �, 50750 : 32.379 10.750 _,25.449. 6w5h
z7H57254;. .. Y56.750 '
S7260 72.
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t
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e
VINYL WINDOWS AND PATIO DOORS COLLECTION I JELD-WEN
ENERGY EFFICIENCY CHART
There are several ways to measure the energy efficiency of a window or patio door The following chart shows the "
critical factors related to the energy efficiency of Summit vinyl windows and patio doors.
c 5. SUMMIT ENERGY HART VINYL`WINDOWS AND PATIO DOORS
�. ky ...+ma`s
:� � � �',�,�`� �a .at �-� � � � r'1"., a�• ^e-" y r�,,.�1��"`�.��'c���. ���� SOUnd,T�ranS��c
n a ' 44-FYy*a F " Ce5? mr �,1.� 1' tm k 1. ' sxa 'i X`,+�
Structural Ratings mission Ratings�i
FRC Certifie ��Rr pSTC` OITC' :
in.H.. �,� `� z'y� ," e ,,,,
a �' d Factor SHGC: .
,W.
-Series
0,44 0.48 0.49
Casement 8610 V IG Clear 0 33 0 27 0.44
IG HP Dual Coated Low-E 24
IG HP Dual Coated Low-E with argon 0.31 0.27 0.44 0.06 6.00 R30 27
0.43 0.48 0.49
Awning 8610 V IG Clear 0.33 0.27 0.44
IG HP Dual Coated Low-E 29 24
IG HP Dual Coated Low-E with argon 0.31 0.27 0.44 0,09 3.00 R20
0.48 0.66 0.70
Geometric and IG Clear 0 32 0.36 0.61
Radius 8630 V IG HP Dual Coated Low-E R20
27 23
IG HP Dual Coated Low-E with argon 0.49
30 0.36 0.61 0.01 3.00 -
Sierra Single-Hung
IG Clear 0.49 0.66 0.69
0.35 0.35 0.60
Side-Load IG HP Dual Coated Low-E
IG HP Dual Coated Low E with argon 0.32 0.35 0.60 0.05 5.25 R35 27 22
0.49 0.66 0.69
Sierra Slider
IG Clear
0.35 0.35 0.60
IG HP Dual Coated Low-E 3 00 R20 26 22
--` 0.32 0.35 0.60 0.18
IG HP Dual Coated Low-E with argon
v - 0.48 0.69 0.72 -
Sierra Geometric `IG Clear 0.33 0.37 0.63 1
and Radius IG HP Dual Coated Low-E
IG HP Dual Coated Low-E with argon 0.30 0.36 0.63 0.01 3.00 R20 25 22
/
0.50 0.63 0.65
Sierra Single-Hung
IG Clear
0.35 0.34 0.58 t
Tilt IG HP Dual Coated Low-E R25 27 22 r
IG HP Dual Coated Low-E with argon
0.32 0.34 0.58 �0.28 3.75
Sierra Double-Hung
IG Clear 0.48 0.59 0.61 ,
Tilt IG HP Dual Coated Low-E
0.35 0.32 0.54
IG HP Dual Coated Low-E with argon 0.33
0.31 0.54 ; 0.13 4.50 R20 27 22
Sierra
IG Clear 0.49 0.66 0.70 ;
i
0.33 0.36 0.61 �
Geometric and IG HP Dual Coated Low-E 0 of 5.25 C35 26 22
Radius IG HP Dual Coated Low-E with argon
0.29 0.36 0.61 {
Sierra Sliding
IG Clear 0.47 0.65 0.65
3
33 0. 5 0.60
Patio Door IG HP Dual Coated Low-E 0. 5.25 R20 31 30
IG HP Dual Coated Low-E with argon
0.31 0.35 0.60 0.11
0.49 0.67 0.71
Sierra Brickmould `IG Clear 0.33 0.36 0.62
Option Geometric IG HP Dual Coated Low E 30 0.36 0.62 0.01 .7.50 R30 25 21
and Radius IG HP Dual Coated Low-E with argon 0.49
Sierra Brickmould
IG Clear 0.49 0.58 0.60
0.35 0.32 0.53
Option Horizontal IG HP Dual Coated Low-E
Slider IG HP Dual Coated Low-E with argon 0.32 0.32 0.53 0.17 3.75 R20 25 21
0.51 0.58 0.60 1
I
Sierra Brickmould IG Clear 0.35 0.32 0.53
Option Single-Hung IG HP Dual Coated Low E
IG HP Dual Coated Low-E with argon 0.33 0.32 0.53 0.21 3.00 R20 25 21
I
i
k
Footnotes refer to glossary on next page.
7 7,��"'^, '34 �zt.:.t"5, .w,pry'.; 'tea was: u a
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d y t,} t � �• I fin,'� �� ?�, a' `�`x-�" .R'�`R {k X`ropE,' `a
u,._ .,.c t;y •* ' _ `'w ,'r2x x-sew t''
a� .,:*'�v.° `•`f r ^� ,'�* x
"' h"
<7 . . .� -• Y CkIART,,�s a;� im'��� �=;-€a
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P%`�.hg�.sF ,�;,.�r tr� t�-•��' n� �fr�`a:n� K';��a" �'��a�.; ;e� ,�.':i:ss;s1d;`s�"���u�.' ,.:.w :ow.w -
.�
E`PTIC SYSTEM MUST BE
tr
� ` °���LLE® IN COMPLIANCE cFTHE
�Asses*sor's. map;and lot number ..............:.....:.... I
H TITLE 5'3 Q� �
0e,ewage Permit'' number . ...i 01,AONMENTAL CODE AND
ac./ TOWN REGULATIONS = BAWSTABLE,
` HOUSe number ..... `�............� .... .... ...... ...... 9� Mb 9 0�
J�3O, 'FD Mix
i�do _ •� TOWN OF BARNSTABLE
BVILDIH G INSPECTOR
APPLICATION FOR PERMIT TO 9 O G- Af-MCk...."' EIJC,
................ ................... .. . . ..... ..... .........
o,ec tf
•TYPE OF CONSTRUCTION D Oil/.................................................................................. ........
..........................^..�'!.��.......19d 7
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ... ............ Q........sC �� I........ .I�.....,r....cozz/ ,.�..........................................
Proposed Use��X,_-- ��/y!/aL 5�...... .................................................................
.... ..........................I.... ....... .....
ZoningDistrict ....((...��.....'�--.��.........................................................Fire District ..............................................................................
Name of Owner---W.. `'f �..... /U�lL... l Address L JCS... �,� Cqq v Ir
. n ... l... .Y............
Name of Builder'P�/�....C,�.O.Tg�V.."��cldress 5 � .
Name of Architect ........... .............................Address .:................. I' €�G-.......................................
Number of Rooms ..................................................................Foundation ....Cyr!�l/C.�.�•�F/—, .....................................
Exterior 9PEtw! lT .... J .................Roofing .. ! ! !4T................................................
Floors ` � ��/l/` ..... ...................Interior T OC.. ......................................
.. .....?:��...............................
Heating / :....................................:...........................Plumbing..����.�.,.....................................
...............
Fireplace/ .:................................................................Approximate Cost ....... .... ...,...... ....../�Cr,37 vim.
p, n L`
Definitive Plan Approved by Planning Board i'___/_ _-�___-___27__19_Q_2. Area :.. ... . �L ...C!�.G
y� po
Diagram of Lot and Building with Dimensions: 2 — � Fee ...................0
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Nam ..... ............ ..1qCA\1 .......................
Construction Supervisor's License ... D� I�................
O'Neil, Stephen
No .....�W.aL Permit for .......dormer & enclose
...........................
........P.Q.r,q .............................................................
Location ............6..7...Sc.r.e.ech.a.m,.Wa.y..................
totui
.. ..........................C.....................................................
O'Neil
wf 0 ner .............. .....................................
Type 6f'Construction ...............frame.................
.. ................................. ..............................................
Plot ............................ Lot .................................
Permit Granted ........... ...............19 87
Date of Inspection .....19
Date Completed ........ ..............19
A
r
� rV
1'rAssessor's map and lot number ......... ........ ..1/1 .k.
T E
,30--Sewage Permit number ... ............. 0
ft9 J-` Z BAUSTABLE. i
+�'�House number ..... ............... -`.::................
:.................... ' Saes �
�� i639-f. 9�
�f0 MAY Or
TOWN OF BARNSTABLE
BUILDING1 INSPECTOR
APPLICATION FOR PERMIT TO . '.',� 471 Z.-................... ;'......51 .!!�d��. ... N .
TYPE OF CONSTRUCTION � �7/G'�li
............................................. 1 04C.�...........
.................... ..19&Z
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
�CC'�1� l�l/� (� ��fJTU/�'
Location ..................................................... r-..:........... '/.....................T......s...:...................................,.,..............................
Proposed Use ,/ ' 'r :......... '��-��'✓YI/�t. S � GUG //1/tom...................................... ......... .........
Zoning District . .. s ........................................................
_..................................Fire District,,...:..:.::'.: ":
Name of Owner � �-* �'L/„? j1/ /c� ''.l T.Address 7 � GIJ/ °✓G�� t 'G!� �%....
Name of Builderi��`. = .:.. . :3.7 �V ": ciclress Z � ....t f/%��Llf!LL:�=.............
Name of Architect ..........�-=�- 9�'�'� ..............................Address `-r %
Number of Rooms ..................................................................Foundation .... e'l/,C�. .....................................
Exierior 9Q ,c � (f//-//TT � /�c -* `Rr� �•Z 7 ........... .. ........
.......... ................................ .........................Roofing ..... :...�..../.:�........................................
Floors �` .�1. /.'r:' ` .� ri G? .......................................
r
...................................................:. . .............................Interior .................:.....• .
Heatingl'� .................................. ................Plumbing
................ ................ .................................................................
Fireplace pp
A roximate. Cost r..... �+
Definitive Plan Approved by Planning Board r'_____`_-------_---.___-27__19 4_G . Area �...�f!4.q....
�+{?
Diagram of Lot and Building with Dimensions
g g i Fee ........... ...........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
t
L
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above '
construction.
l
Name(... . . Ui:;.l...... !1::+!..5..:..4 . A........................
Construction Supervisor's License ... a �s.............
O'Neil, Stephan I A=022-131
No ....30737 Permit for .....dormer...&
...... ...............
enclose porch
............................................................
Location ..............67............Screecham.............Wa....y...............
............................Cotuit
a
Owner Stephan O'Neil
Type of Construction frame
..........................................
................................................................................
Plot ......................... . Lot ................................
Permit Granted ............MaY..12...............19 87
Date of Inspection ....................................19
Date Completed ......................................19
Iva"
TOWN OF BARNSTABLE
o� •. Permit No.
{ ���� Building Inspector
Cash
"us. --------------
o +bw•
OCCUPANCY PERMIT Bond _.__-
Issued to Lexa-%d Bi,6c.aAix Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date z7y
Board of Health Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIC-NED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
19.....
/ Building Inspector
FROM _ - -
LE
i�� #RtOt# 9ti$f!f' i�lil�lp �7�g✓ iiNe
roavt Ct - W7 MAIN STREET HYANNIS,
Phone: 776-112t
SUBJECT: , -
-FOLD MERE
DATE.
M E SeYSA G,E
.,DATE - -
R E P.L Y`
SIGNED
77
N87•RMI ` - - 'RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY
PRINTED IN.U.S.A.
— SENDER: SNAP OUT,,YELL"OW.COPY ONLY.SEND WHITE ANDIPINK COPIES WITH CARBON INTACT. _
hl�r�( C,AeB�t..6• G�uD�.tZ ..._—. _ . — /�9,a v -- •`r ,
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71
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AP P1..1.G A�t•t �/ . /��c-rS�/f�� //S/C
I To 'DfrTer-miwE.. oT UW54.
0 r«,
c I bI- -;Assdssor's map and lot number .............:........:....... tl 6� ���' M
CON
mA LED °
L
r
Sewage Permit number .................... ....... WITH TITL
/� r
Kam.. .s ��(. .� "GlAIe 81�B�ABtkD E,
House number ........... .. ...................... k�'�r',� " s
'Fa-MR1 tr'
TOWN OF BARNSTABLE L
BUILDING -INSPECTOR
APPLICATION FOR PERMIT TO. .... .�'"." ,fit..: ......: ...... . ..................................... ..
. .... . . . .,........ ...
TYPE OF CONSTRUCTION ..........................(Aj.,0......4.........................................................................:......
...................19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit
� accordi g to the following information:
Location ....... . -.�. .. . .0 ....... � .' ..... ......L�!!.. ....�....... .. v :........................
ProposedUse .................................................. . . . ... ..
Zoning District ........................Fire District ......... . ......... ......................... .......... ........
Name of Owner .. . _ !I,ll.4� �!IA.Addres �; f4�y�/.P"! .. 1..��.. .� ` V�/C�
Name of Builder ..../. � r ... ... ......Address ....... ..........a..............
Name of Architect ........:...... ......... . .. ..............:..........Address ................... ....
Number of Rooms ...... ............ .... ..................................Foundation ........
Exterior ........... � ... ..I.:.... ..�...,..........................................Roofing ......... ... ... .. ...... .... ............. .............................
.Interior %'..�
Floors. .. .......... ..................................... .............................. ...��.:-lJ........................................
Heating .I. rr ..........Plumbing ......... _ - ----
. . .. . .... .. . .. ..
en
Fireplace ........... /�ii ............................:.......................APProximate Cost ............ . ....®`t..�...`"..V..`........:.
........./.
Definitive Plan.Approved by Planning Board ________________________________19 J� Area .... ...........
Diagram of Lot and Building with Dimensions Fee ..........................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
S P166W 7
d F6,
0� �
hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin the above
construction.
Name ........ ....... .............. ... ..............
—T_ -- -� - - - -- - —
'
~� ^
. . . .�
.
|
-
' , ---
. . `
~
' . .
, .
^ . �
- !
Sinqle Family Dwelling
Cotuit
PERMIT REFUSED
.....---__----.---------.. lV
.—i--..�--------------------.
'
...� ..—.....—..—. —.—.-----------.
,.
., '
—_---.--.--.---.—.—.—~..—...--.-�
- . `
.............................................................
-r
^ Approved --------------'—. 19
^ . '
{
� -------------.—.------'----... .
' . ----~-----
- ~ .
Assessor's map and lot number ............................... ' 'C -
d THE t��1
�Q r� O
Sewage Permit number ...........�...�: .:........�.
,n, �p*[j /� /J�/� _ Z BJBB9TADLE, i
House number .......... G/.. f,...... L /C�++y/+ �4 yO MABa
:..... `„� ���CCC
1639. \e0
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ... fC
.. ...... .......
TYPEOF CONSTRUCTION ..........................4-16.�q.j..................................................................................
............. !..... .19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
f
Location € �� / .�� . ... ........� .A.................:..................................................
...... .........
Proposed Use : ?./ram. ►'+C-�+r ..........................................................
Zoning District ......................Fire District 'r............. J ......... .. ....... _... ' t. .....................
Name of Owner I 11 (). . ........ ")KAi .1-Address �.�%/..t�����..�..�.j�.�.../47 M 09
.. ...........
t
Name of Builder .... !.. .. //C.. 'r ......Address ...... .....................................................................
Name of Architect ........... - s. ... .......................Address '
Number of Rooms ......:. .................................Foundation .......,. ....d�— ��
A
P..
Exterior ...........� .. .......................................Roofing ....... .....f��: .........e ...........................
Floors .....................Y......................................Interior .........:.� .....:... ..... `-!!...........`
P
Heating ... } I. .....................................Plumbing ....... y' ®fiA .............................
Fireplace ........... �. .....................................................Approximate Cost ............. .. ......................
Definitive Plan Approved by Planning Board ________________________________19_ "' Area ..........................................
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
f166W -?
�---
aF6,
-�j
�y
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
25 Z15c 0 j Name ...........................................................................
BISCARDI, LENARD A=22-131
No ...25556 permit for Two Story
Single Family Dwelling
..... ...............................................
Location ..... ot 10 , 67 Screecham Way
...................................................
Cotuit
..........................................................:....................
Owner .......Lenard Biscardi
................................................
Type of Construction ....Frame
................................................................................
Plot ............................ Lot ................................ ".
Permit Granted ,,, Sept. 19,........... 1'9 83
...........
Date of Inspection ....................................19
Date Completed 19
4:!Fs7m
PERMIT REFUSED
�5..... �:..... .\ ........ 19 �Q
................. �Ao......�!2 LLj��................
/........ l vl !!
...........................................................................:....
3
Approved ................................................ 19
...............................................................................
' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
L, r
Map Z 1i Parcel �3' - Permit# 7�
Health Division +qq W Date Issued
Conservation Division PAO Fee
Tax Collector �, �j�/j .
SEPTIC SYSTEM MUST E
j!
Treasurer �lO / a INSTALLED IN COMPLIANC
Planning Dept. WITH TITLE 5
i ENVIRONMENTAL CODE AND
Date Definitive Plan Approved by Planning Board TOWN,REGULATIONS
Historic-OKH Preservation/Hyannis -
. P
Project Street Address 7 6-
t ,
Village i
-Owner Address
Telephone '
Permit Request lf1,0A1f ,
&R(_0A
Square feet: lst floor:existing proposed Iva ► 2nd floor:existing proposed Total new
Estimated Project Cost 170O 6 Zoning District Flood Plain Groundwater Overlay.
Construction Type � E
Lot Size Grandfathered: ❑Yes 0 No If yes,attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ANo . On Old King's Highway:' ❑Yes No
Basement Type: ❑Full ❑Crawl• �❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new C Half:existing +new
Number of Bedrooms: existing new/ Al9 r
F
Total Room Count(not including baths):existing new -First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric- ❑Other
Central Air: ❑Yes ❑No' Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:'D existing ❑new size Barn:❑existing '❑new size
Attached garage:❑existing ❑,new size .Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization O Appeal# Recorded❑ '
Commercial ❑Yes. ❑No If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
1 Name Telephone Number ;'Ob 1776
Address ► �Oo°+V �License#
_9J 4* 1111 16 VHome Improvement Contractor# /f�/
Worker's Compensation#
ALL CONST CTION DE IS RESULTING FROM THIS.PROJECT WILL BETAKEN TO
V LB
SIGNATURE DATE _ I6
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
IT
MAP/PARCEL NO. -
_, re•r t • �'f
ADDRESS VILLAGE
OWNER.'-'
DATE OF.INSPECTION
FOUNDATION,,.
}
FRAME
INSULATION
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ELECTRICAL: ROUGH rn FINAL t ;
PLUMBING:, -ROUGH FINAL
GAS: ROUGH rrn : . FINAL-
ccF
FINAL BUILDING �. �
DATE CLOSED OUT
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ASSOCIATION PLAN NO.•i p 0 c
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The Town of Barnstable
� 'AM �e Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 J Building'Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements. 13 , I �
i 46 &�y
Type of Work: V Estimated Cost B®O
Address of Work:
* 4
Owner's Name: f4v vc
Date of Application: Ato la
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job Under$1,000
Building not owner-occupied
00wner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby a ply for a permit as the agent of the owner.
Date Contractor Name Registration No.
OR
Date Owner's Name
q:forrns:Affidav
--_- - The Commonwealth of Massachusetts
Department of Industrial Accidents
_ =- Office 9111105ti .090s
600 Washington Street
-
.�r�4;�• Boston,Mass. OZlll
Workers' CoT n Insurance Affidavit
name:
location: °
riri j NL42 phone# r E
�I am n home vner performing all work myself.
I am a sole proprietor and have no one tivorking in anv ca ac'
❑ I am an employer providing workers' compensation for my employees working on this job.
company name:
address:
city: phone#:
insurance co. polim#
❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who
have
the follo«ing workers' compensation polices:
company name:
address:
city: phone#:
insurnnce ca. oltev#..
company name.
address:
city .... phone M
Insurance co. oliev# :...:..:::;.;:;::; ;.:,_;:;,,..:::..:..
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of cri final penalties of a fine up to S1.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OlUce of Investigations of the DIA for coverage vetitication.
Ida hereby certij nder the Xiiand=of at the information provided above is truce d coned
Signature Date _
Priest name A 0 Phone# A75
--------------
official use only do not write in this area to be completed by city or town official
city or town: permitilicense# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Ot11ce
❑Health Depar =t
contact person: phone#; ❑Other
(revisea W95 P1A)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another under any co=-.z-.
of hire, express or implied, oral or written.
An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive: c:
trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews:
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
.,being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you
.are required to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be rewrnid io
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
E MEN
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Invesduatlons
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
f a
.,' �'lte �ariv..w�zurea� o�✓�aaoacleuaell$ 11
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number CS 026820
Birthdate:-05/06/1935
Expires:05/06/2000 Tr,no: 7187 .
Restricted To: 00
DONALD B BROWN' .
21 MARY DUNN RD- 6 ••a.e `
HYANNIS, MA 02601 Administrator
HOME._IMPROVEMENT CONTRACTOR
UU
Registratiov-118740
Type,-. INDIVIDUAL
Expiration 04/18/O1. _...
DONALD B. BROW
21 MARY DUNN RD
G� �o iwNIS MA 02601
ADMINISTRATOR
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